Role of endoscopy in management of gastrointestinal complications of portal hypertension

The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy is both diagnostic and interventional and in the last years the techniques have undergone a rapid expansion with the advent of different and novel endoscopic modalities, with consequent improvement of investigation and treatment of these patients. The choice of best therapeutic strategy depends on many factors: baseline disease, patient’s clinical performance and the timing when it is done if in emergency or a prophylactic approaches. In this review we evaluate the endoscopic management of patients with the gastrointestinal complications of portal hypertension.     

Anthropometrics,Hemoglobin Status and Dietary Micronutrient Intake among Tanzanian and Mozambican Pigeon Pea Farmers

Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.     

Influence of Fishing Technique on Organochlorine Pesticide Accumulation in Fish and its Possible Human Health Risk in the Republic of Bénin

In Bénin different techniques are used for large-scale commercial fishing, Acadjas (enclosures constructed in the river) and Whédos (holes made in the river banks). This study aimed at assessing the extent of contamination related to these fishing techniques. Fish contained residues of DDT and its metabolites, α-endosulfan, dieldrin, aldrin, endrin and lindane. Pesticide levels were similar in fish from Acadjas and Whédos, except for higher α-endosulfan levels in fish from the Whédos. Comparing pesticide intake levels through fish consumption with tolerable daily intake levels showed that in all cases risk for human health is low.     

Kaliumchlorat-Vergiftung,tödliche,durch Gebrauch als Abtreibemittel

Ohne Zusammenfassung     

Molecular mechanism of target recognition by subtilin, a class I lanthionine antibiotic

The increasing resistance of human pathogens to conventional antibiotics presents a growing threat to the chemotherapeutic management of infectious diseases. The lanthionine antibiotics, still unused as therapeutic agents, have recently attracted significant scientific interest as models for targeting and management of bacterial infections. We investigated the action of one member of this class, subtilin, which permeabilizes lipid membranes in a lipid II-dependent manner and binds bactoprenyl pyrophosphate, akin to nisin. The role the C and N termini play in target recognition was investigated in vivo and in vitro by using the natural N-terminally succinylated subtilin as well as enzymatically truncated subtilin variants. Fluorescence dequenching experiments show that subtilin induces leakage in membranes in a lipid II-dependent manner and that N-succinylated subtilin is roughly 75-fold less active. Solid-state nuclear magnetic resonance was used to show that subtilin forms complexes with membrane isoprenyl pyrophosphates. Activity assays in vivo show that the N terminus of subtilin plays a critical role in its activity. Succinylation of the N terminus resulted in a 20-fold decrease in its activity, whereas deletion of N-terminal Trp abolished activity altogether.     

Assessing "occult" cervical cord damage in patients with neuropsychiatric systemic lupus erythematosus using diffusion tensor MRI

Background

Whereas focal and diffuse brain damage on conventional MRI is seen in patients with neuropsychiatric systemic lupus erythematosus (NSLE), the spinal cord seems to be rarely involved. Diffusion tensor (DT) MRI provides information on the patterns of tissue disruption of the central nervous system, which may go undetected by conventional MRI.

Objective

To quantify the extent of otherwise “occult” injury of the cervical cord in NSLE, and to improve our understanding of its nature.

Subjects and methods

Conventional and DT MRI scans of the cervical cord and brain were acquired from 11 patients with NSLE and 10 healthy controls. Histograms of mean diffusivity (MD) and fractional anisotropy (FA) of the cervical cord and brain were analysed. Measures of cervical cord and brain atrophy and focal lesion loads were computed.

Results

Only one patient had a single focal lesion of the cord whereas all had multiple brain lesions on conventional MRI scans. Cord and brain volumes did not differ between patients and controls. Mean peak height of the cervical cord MD histogram (p = 0.0001) and average brain FA (p = 0.001) were significantly lower in patients than in controls. Average cord MD was correlated with average brain MD (r = 0.69, p = 0.01) and FA (r = −0.81, p = 0.002).

Conclusion

DT MRI shows mild and otherwise “occult” cord damage in NSLE, which might be secondary to Wallerian degeneration of long tract fibres passing trough damaged areas of the brain.Systemic lupus erythematosus (SLE) frequently affects the central nervous system (CNS), leading to a condition which is termed neuropsychiatric SLE (NSLE).¹ Diffuse immune mediated tissue damage, focal ischaemic lesions and vasculitis are all potential pathological substrates underlying CNS dysfunction in NSLE. However, in contrast with other “diffuse” CNS disorders, cord damage seems to be a relatively rare feature of NSLE,² outside the context of acute myelitis.³Diffusion tensor (DT) MRI provides quantitative indices of the structural and orientational features of the CNS tissues.⁴ The increased sensitivity of DT MRI over conventional MRI in detecting tissue changes associated with demyelinating⁴ and ischaemic vascular disease⁵ has prompted the use of DT MRI to define the actual extent of brain damage associated with NSLE.^6,7,8 However, to date, no DT MRI study has investigated the features of NSLE pathology in the spinal cord. Using a DT MRI sequence tailored to cervical cord imaging,⁹ the present study was performed to assess the overall extent of otherwise “occult” damage of the cervical cord in patients with NSLE. We also assessed the correlation between the extent of such cord damage with that present in the brain in an attempt to improve our understanding of its nature.     

Susceptibility pattern of Neisseria gonorrhoeae to antimicrobial agents in Dar es Salaam

This article presents a study on the susceptibility pattern of local strains of Neisseria gonorrheae (NG) to antimicrobial agents (penicillin, doxycyline, erythromycin, cefuroxime, ciprofloxacin, cotrimoxazole, and spectinomycin) in Dar Es Salaam, Tanzania. Out of the 429 isolated strains of NG in 1993-95, 199 were included in the study. Susceptibility patterns to the six antimicrobials was determined through the E-test method, a test that measures their minimum inhibitory concentrations (MICs). On the other hand, the spectinomycin MIC was determined through the antibiotic agar dilution method. Results revealed the following patterns of susceptibility of isolates: spectinomycin (100%), ciprofloxacin (97%), Cefuroxime (89%), erythromycin (57%), cotrimoxazole (40%), doxycycline (7%), and penicillin (10%). It was also noted that NG strains are highly resistant to penicillin (64%) and doxycycline (88%). The study concludes that three drugs--spectinomycin, ciprofloxacin, and spectinomycin--could be effective in treating gonorrhea. However, a continued surveillance of common antibiotics against gonococcus is necessary for the early detection and control of strain resistance.     

Mature glycoprotein g presents high performance in diagnosing herpes simplex virus type 2 infection in sera of different tanzanian cohorts

Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted infection in sub-Saharan Africa. Glycoprotein G (gG) of HSV-2 elicits a type-specific antibody response and is widely used for serodiagnosis. gG is cleaved into a secreted portion (sgG-2) and a highly O-glycosylated mature portion (mgG-2). The performances of these two native immunosorbent purified antigens were compared in an enzyme-linked immunosorbent assay (ELISA) format with a commercially available assay (FOCUS2) using sera from blood donors (n = 194) and individuals (n = 198) with genital ulcer disease (GUD) from Tanzania. Discordant results were resolved by Western blotting. The HSV-2 seroprevalence for blood donors was estimated as 42%, and that for the GUD cohort was estimated as 78%. The prevalence increased significantly with age for both cohorts and was higher among human immunodeficiency virus (HIV)-positive individuals than among HIV-negative subjects. In the GUD cohort with a high HSV-2 prevalence, all three assays showed statistically similar performances, with sensitivities between 97% and 99% and specificities in the range of 86% to 91%. In contrast, among blood donors with a lower seroprevalence, the mgG-2-based ELISA presented significantly higher specificity (97%) than the sgG-2 ELISA (89%) and FOCUS2 (74%). Overall, the mgG-2 ELISA gave a high performance, with negative and positive predictive values of 96% for blood donors and a negative predictive value of 95% and a positive predictive value of 97% for the GUD cohort. We conclude that native purified mgG-2 showed the highest accuracy for detection of HSV-2 in patient sera from Tanzania and is therefore suitable for seroprevalence studies as well as in clinical settings.     

Naming speed and visual search deficits in readers with disabilities: evidence from an orthographically regular language (Italian)

The study examined rapid automatized naming (RAN) in 42 children with reading disabilities and 101 control children—all native speakers of Italian, a language with shallow orthography. Third-, 5th- and 6th-grade children were given a RAN test that required rapid naming of color, object, or digit matrices. A visual search test using the same stimulus material (but not requiring a verbal response) and an oral articulation test were also given. Readers with disabilities performed worse than controls on the RAN test. This effect was larger in higher grades than in lower ones. Readers with disabilities were also slower than controls in performing the visual search test. The pattern of results for the RAN test held constant when the visual search performance was partialed out by covariance analysis, indicating the independence of the 2 deficits. The 2 groups did not differ for articulation rate. Finally, analysis of the pattern of intercorrelations indicated that reading speed was most clearly related to RAN, particularly in the group with reading disabilities. The results extend observations of RAN effects on reading deficits to Italian, an orthographically shallow language.